Healthcare orders are requests placed by healthcare providers, such as physicians and nurses, for example, for medication and non-medication tasks to be performed for a patient. An order may include, for instance, a request for a procedure, a medication, a laboratory test, an evaluation, a treatment, or a nursing task to be performed. A variety of electronic order management systems have been developed for clinical environments that allow healthcare providers to enter and manage orders for their patients. One example of such an electronic order management system is the POWERORDERS application available from Cerner Corporation of North Kansas City, Mo. For instance, using such an order management system, a physician wishing to prescribe a medication for a particular patient may access a profile for the patient and initiate an order for the medication, entering details for the medication order. After initiating the order, the physician may “sign” the order, indicating to the order management system to process the order. Once the order has been processed in the order management system, it is electronically dispersed to the appropriate location, such as a pharmacy, so that care can be administered based on the directives of that particular order. In addition, the order is maintained in the profile allowing other clinicians to view the order, as well as any other orders that have been placed for the patient.
Some electronic order management systems provide sophisticated features to assist healthcare providers in the care process. For instance, when a physician enters a medication order, a system may perform dose range checking to determine whether the dosage entered by the physician is appropriate. In addition, a system may determine and/or warn whether the patient has any allergies to the medication. Further, some systems perform conflict checking by comparing orders being entered against orders already within the profile to determine if a conflict exists. For example, a system may perform interaction checking to determine whether an adverse interaction exists between a medication order being entered and any medication orders currently within the profile. In addition, a system may perform duplicate checking to determine whether a medication order duplicates a current medication order for the patient.
To accurately perform conflict checking in which orders being entered are compared against existing orders within a profile, such as for interaction checking and duplicate checking, an order management system must have a static profile between the time of checking and the time the order is processed. For example, some systems allow multiple users to simultaneously access a profile and enter orders. If such a system were to perform interaction checking when a healthcare provider initiates a medication order, the system may miss interactions with any orders that are entered by other users and processed by the system between the time the medication order is initiated and when the order is processed. Accordingly, such systems that allow multiple users to simultaneously enter orders typically perform conflict checking at the time a medication order is processed. Although such an approach prevents the system from missing superseding orders for conflict checking, the approach presents a drawback and area of inefficiency. In particular, a user must enter all the details of an order before any conflict checking is performed. If a conflict is determined, the order may not be processed and the time taken to enter the details of the order is essentially wasted. The drawback is accentuated for cases in which a user is entering an order set, which may contain over a hundred orders and require a substantial amount of time to enter. In such cases, a user enters the details of all the orders, and conflict checking is then performed for each of the orders. If any conflicts are determined, the system may allow the user to process the orders that do not have a conflict while removing the orders having a conflict. However, such removal may disrupt the context of the order set.
Another approach to provide a static profile for conflict checking is to place a lock or reserve on a profile when a user is entering an order that will require conflict checking (i.e., a lockable order). For example, when a user initiates a medication order, the order management system will determine that the order is a lockable order and lock the profile, thereby preventing other users from entering other lockable orders while the profile is locked. By doing so, the system has a static profile for conflict checking from the time the medication order is initiated until the order is processed. If a conflict is determined, the user is notified right away, instead of being notified after already having entered the details of the order. However, such order management systems that provide profile locking also present a drawback. In particular, other users are prevented from initiating and entering details of lockable orders while the profile is locked. In addition, the users must continuously check the profile to determine when it becomes available. Accordingly, a user wishing to enter a lockable order into a locked profile must continue to check the profile to determine when the profile becomes available, obtain the lock for the profile, and then initiate his/her lockable order.